Therapy-Induced Changes in Head and Neck

Abstract

Radiation with or without concomitant chemotherapy of the head and neck region is associated with acute and chronic toxicity and adverse effects on organ function. Therapy-induced dysphagia is a complex multifactorial disorder, constituting one of the most common and prominent problems affecting quality of life of the patients. Classical fluoroscopy is still the method of choice to search for morphologic (fistula, stricture, resection defect) and functional (impaired sensory or motor function of the pharyngoesophageal tube and larynx, xerostomia) deficits. Bone injury is another severe, although relatively rare, condition induced by radiation and specific drugs, especially bisphosphonates. While fatty replacement of the bone marrow within the radiation field is a deterministic effect without clinical significance for the patient, radiation-induced inflammation, fibrosis, disorganization of extracellular matrix, and tissue remodeling may lead to devitalized bone with mucosal ulceration, pathologic fracture, and fistula formation. Similar effects have been associated with osteoclast-inhibiting therapies, including bisphosphonates and denosumab.